Do I have hypothyroidism?

[kate0417]

Hi there,
I have an endocrinology appt on tuesday.  Results are on attached.  Am I on the verge of having Hashimoto or hypothyroidsm.
Symptoms:  cold feet at night, hot/sweating in 30 degree weather, memory loss,depression,
exercise like a maniac but can't lose weight (5'3 - 144lb),  throat feel like it need a blanket underneath to separate by skin, High LDL, low Vitamin D.

[kate0417]

Thanks again for your great insight to this as I am new to this! Dr prescribed 50mcg of levothyroxibe and ordered labs in 6 weeks.  Dr also will let my family physician manage this from now on until my tpoab gets elevated with annual thyroid labs checkup.

[goolarra]

Well, there's nothing wrong with a doctor looking at labs.  It's one of the pieces of the puzzle, and it should be used.  It's when they argue that you're "fine" or you're "normal" when labs are in range and ignore raging symptoms that you have to worry about them.  I wouldn't trust a doctor that ignored labs any more than I'd trust one who ignored symptoms.  

Your doctor is offering you medication for thyroid despite the fact that your thyroid numbers look quite good.  This tells me that he must be listening to your symptoms.  If he were looking only at your numbers, he wouldn't be giving you meds at this time.

Your thyroid is enlarged, which also indicates something is going on.

I think you made the right choice, and quite frankly, I'm impressed that this doctor offered you a choice of meds.  Most doctors would look at your labs and throw an antidepressant at you.  

Do you know how much levo you'll be taking?

[kate0417]

So doc told me, I have some choices ... Depression meds, levo meds or wait and see approach.

He did an ultrasound and did say that my thyroid was enlarged.  

I took the levo choice and think it's time for me to seek a new doc?

Did I make the right choice?  He said my levels are within range which tells me that he is a labs guy

[goolarra]

Antibodies can vary wildly.  Also, antibody levels on diagnosis of Hashi's are usually astronomical.  My TPOab was 900+, and my TGab was 3,000+ when I was diagnosed.  These are not unusual numbers.  TPOab can be somewhat elevated with other autoimmune diseases.  Furthermore, some people have antibody counts like mine for years, or even decades, before enough damage is done to the thyroid to cause symptoms and out-of-range blood work.  

[kate0417]

I'm cleaning up today and found my blood work from last year.  I'm just anxious as my appointment is tomorrow.  My TPO in jan 2014 was 17 (<35) thyroglobulin ab <20 (normal is under 40)

Tsh, t3, t4 are similar numbers.  Should I be concerned that my TPO has been increasing since Jan 2014?

Normal TPO <35
Jan 2014 - 17
July 2014 - 28
Feb 2015 - 38

[kate0417]

Thank you so much for your insight! I will keep you posted on my visit Tuesday.  I am so glad that we are able to get somewhere with these symptoms I have for years.

[goolarra]

You might talk to your doctor or a dietician about the D supplement.  With a deficiency like yours, 50,000 IU per week is often the prescribed dosage, cutting back as levels rise.  You're only taking about a tenth of that.  

The reason I asked about postpartum is that there's a condition called postpartum thyroiditis (PPT).  It starts out anytime from delivery to a year after and is first hyper and then there's a hypo phase followed by a return to normal.  Although that's the typical pattern, some people only have the hypo or hyper stage.  Antibodies are elevated with PPT, which is considered a variant of Hashi's.  Do you think this could in any way be related to your daughter's birth?    

[kate0417]

Thank so much for answering my post!!! Much appreciated!!

Yes I have been supplementing vitamin d for 3 years 2-400 iu pills a day and still under the range.

I actually thought all my symptoms were postpartum especially with my hair loss but my daughter is 3 years old now.  I do have 4 kids and not planning to have anymore.

[goolarra]

Are you supplementing D?  If you don't have adequate vitamin D, thyroid hormones can't get into cells and do their work.  So, you can feel hypo (because you are at the cellular level) even though serum FT3 and FT4 levels are fine and your thyroid is functioning well.

If I were you, I'd work on the D deficiency to see if that helps you feel better.  If you get your D levels up and your symptoms don't resolve, revisit thyroid for sure.  

Was the goiter not confirmed on ultrasound?

You're not recently postpartum, are you?

[kate0417]

Vitamin d is 24.6 (normal range is 30-60).  I did have a goiter 6 months ago found by my family physician but normal ultrasound.

[goolarra]

Your FT4 looks good.  It's 46% of range, and 50% is the target, so yours is right there.  FT3 is low at 26% of range (target for FT3 is 50+%.  However, a lower FT3 isn't unusual for people not on meds.  TSH is right where it should be.

TPOab is somewhat elevated, but it's not nearly as elevated as we usually see it on diagnosis of Hashi's.  Antibody counts can vary wildly, even intraday, so the change from July to now could be pretty insignificant, unless it represents a trend.

Some of your symptoms are hypo, some not.  Heat intolerance is not a typical hypo symptom.  

How low is your vitamin D?  How does your throat feel?  

[kate0417]

My ranges are in parenthesis

Normal Ranges
Thyroid Stimulating Hormone serum - 0.30 - 5.10 (1.12)
anti-thyroid peroxidase antibody - <35.0 (38.3) (in July 2014 it was 28)
thyroglobulin antibody  - <40 (<15 IU/ML)
thyroxine serum, free - 0.73-1.95 (1.29)
triiodothyronine, free, serum 2.3-4.2 (2.8)

[goolarra]

Did they give you the reference ranges for any of those?  Ranges vary lab to lab, so they have to come from your own lab report.